[Congressional Record (Bound Edition), Volume 156 (2010), Part 10]
[Extensions of Remarks]
[Pages 13497-13498]
[From the U.S. Government Publishing Office, www.gpo.gov]




   INTRODUCTION OF THE PERSONALIZE YOUR CARE ACT OF 2010 WHICH WOULD 
PROVIDE COVERAGE UNDER MEDICARE AND MEDICAID FOR VOLUNTARY ADVANCE CARE 
   PLANNING CONSULTATIONS; MAKE GRANTS AVAILABLE FOR COMMUNITIES TO 
  DEVELOP PROGRAMS TO SUPPORT ``PHYSICIAN ORDERS FOR LIFE SUSTAINING 
 TREATMENT'' TO SUPPORT PATIENT AUTONOMY ACROSS THE CONTINUUM OF CARE; 
REQUIRE ADVANCE CARE PLANNING STANDARDS FOR ELECTRONIC HEALTH RECORDS; 
       AND ALLOW PORTABILITY OF ADVANCE DIRECTIVES ACROSS STATES

                                 ______
                                 

                          HON. EARL BLUMENAUER

                               of oregon

                    in the house of representatives

                         Tuesday, July 20, 2010

  Mr. BLUMENAUER. Madam Speaker, today I am proud to introduce the 
Personalize Your Care Act of 2010.
  Advances in healthcare have led to increasingly complex health care 
decisions and more treatment options than we have ever had the benefit, 
or the burden, of choosing between. Both Democrats and Republicans 
agree that individuals should be fully involved in decisions related to 
their health care, making informed decisions that reflect their values 
and their needs. We also agree that when people have expressed their 
wishes, those wishes should be known and respected.
  While there is widespread agreement in these principles, too often 
this is not the reality. Most adults have not completed an advance 
directive; if documents are completed, they are not regularly revisited 
and can be difficult to locate. Because these issues are difficult to 
discuss, surrogates can feel ill-prepared to interpret their loved 
ones' written wishes.
  These shortcomings often leave families and health care proxies faced 
with the burden of determining their loved ones' wishes in the midst of 
crisis, sometimes with little or no information about how best to 
direct care. This adds not only stress and anxiety to an already 
difficult situation, but studies show that lack of advance care 
planning actually prolongs the grieving process after losing a loved 
one.
  One of the greatest misconceptions about advance care planning is 
that it is a one-time event. Attempting to plan for all possibilities 
in a single document or within a single conversation is both 
overwhelming and impossible. Early advance care planning is important 
because a person's ability to make decisions may diminish over time and 
he or she may suddenly lose the capability to participate in his or her 
health care decisions. Ongoing conversations are also necessary.
  For advance care planning to be successful, it must become less about 
legal documentation and more about facilitating ongoing communication 
about future care wishes among individuals, their health care 
providers, and surrogates. This approach recognizes that advance care 
documents like advance directives are not the ``ends'', but the 
``means''--the tools for documenting care preferences based on informed 
decisions that incorporate an individual's values, personal goals, and 
current circumstances.
  This process not only provides higher quality care, but personalized 
care.
  The Personalize Your Care Act aims to support advance care planning 
by providing Medicare and Medicaid coverage for voluntary consultations 
about advance care planning every 5 years or in the event of a change 
in health status. This periodic revisiting of advance care documents 
and goals of care recognizes that individual's preference may change 
over time. More so, should an individual develop a serious or chronic 
illness, additional curative and palliative treatment options may be 
available and the advance care plan should be updated to reflect the 
individual's current circumstances and preferences.
  Honoring the expressed wishes of individuals must also be a priority 
and for this to occur, advance care planning documents must be 
accessible where care is provided. To this end, the bill would ensure 
that an individual's electronic health record is able to display his or 
her current advance directive and/or physician orders for life 
sustaining treatment (POLST), so that his or her wishes would be more 
easily accessible and respected. Furthermore, advance directives would 
be more portable to help individuals ensure that advance directives 
completed in one state are honored in another state in which the 
individual needs care.
  And lastly, the bill provides grants to states to establish or expand 
physician orders for life sustaining treatment programs. These programs 
have a track record of promoting patient autonomy through documenting 
and coordinating a person's treatment preferences, clarifying treatment 
intentions and minimizing confusion, reducing repetitive activities in 
complying with the Patient Self Determination Act, and facilitating 
appropriate treatment by emergency personnel.
  These investments in advance care planning will reinforce patient-
centered care--engaging individuals in planning and decision-making 
about their future care and ensuring that those preferences are 
documented, accessible, and can be honored in any state and care 
setting.
  I am proud to introduce the Personalize Your Care Act with the 
support of patient advocates, physicians, nurses, and the faith 
community who see everyday how advance care planning improves 
individuals' and families' peace of mind and the quality of their care.
  I would like to submit for the Record letters of support from the 
AARP, Supportive Care Coalition, National Hospice and Palliative Care 
Organization, and American Hospital Association.

                                           American Association of


                                              Retired Persons,

                                                    July 19, 2010.
     Hon. Earl Blumenauer,
     House of Representatives,
     Washington, DC.
       Dear Representative Blumenauer: AARP is pleased to endorse 
     the Personalize Your Care Act of 2010. Your bill ensures that 
     more Americans have the opportunity to better

[[Page 13498]]

     plan and prepare for their future health care needs. Early 
     advance care planning informs physicians, other health care 
     providers, and family members of an individual's treatment 
     preferences should he or she become unable to direct their 
     own care. This planning and informed decision-making between 
     patients, families, and their health care providers aligns 
     treatment with patients' wishes.
       To help encourage advance care planning, the Personalize 
     Your Care Act would provide Medicare and Medicaid coverage of 
     voluntary advance care planning consultations between 
     individuals and their doctor, nurse practitioner, or 
     physician assistant. Such consultations would occur no more 
     often than every five years unless there is a significant 
     change in the health, health-related condition or care 
     setting of the individual.
       Honoring the expressed wishes of individuals must be a 
     priority regardless of where the care is provided. To this 
     end, the bill would ensure that an individual's electronic 
     health record would include their current advance directive 
     and/or physician orders for life sustaining treatment 
     (POLST), so that their wishes would be more easily accessible 
     and respected. Furthermore, advance directives would be more 
     portable to help individuals ensure that advance directives 
     executed in one state are honored in another state in which 
     the individual needs care.
       Finally, the bill would also authorize grants to establish 
     statewide programs for physician orders for life sustaining 
     treatment or to expand or enhance existing POLST programs. 
     POLST translates the wishes of patients with advanced chronic 
     progressive illness into medical orders that health care 
     systems understand.
       AARP supports your bill to help give Americans peace of 
     mind knowing their wishes for care are understood and 
     respected. If you have any further questions, please feel 
     free to call me or have your staff contact Rhonda Richards on 
     our Government Relations staff at (202) 434-3770.
           Sincerely,
     David P. Sloane,
       Senior Vice President, Government Relations and Advocacy.
                                  ____



                                    Supportive Care Coalition,

                                                    July 15, 2010.
     Hon. Earl Blumenauer,
     House of Representatives,
     Washington, DC.

     Re: Personalize Your Care Act of 2010
       Dear Representative Blumenauer: The Supportive Care 
     Coalition is pleased to endorse the ``Personalize Your Care 
     Act of 2010'' which promotes advance health care planning and 
     provides individuals the opportunity to fully participate in 
     decisions related to their health care or the care of a 
     person for whom they are the proxy or surrogate. The 
     Coalition supports providing a Medicare and Medicaid benefit 
     for voluntary patient-physician consultations regarding 
     advance care planning. These consultations will ensure that 
     an individual's values and goals for care are identified, 
     understood and respected. This legislation also provides 
     grants to states to create Physician Orders for Life 
     Sustaining Treatment programs, allows portability of advance 
     directives across states, and requires standards to include 
     completed advance care planning documents within a patient's 
     electronic record, increasing the likelihood that these 
     documents are kept up-to-date and available.
       The Supportive Care Coalition, comprised of 19 Catholic 
     health organizations with approximately 425 acute care 
     hospitals and 150 long-term care facilities nationwide, works 
     to assure excellence in palliative care in all Catholic 
     health care settings.
       We envision a society in which all persons living with or 
     affected by a chronic or life-threatening condition receive 
     compassionate, holistic, coordinated care. This will include 
     relief of pain, suffering and other symptoms from the time of 
     diagnosis throughout the process of living and dying. Such 
     excellent care will be provided according to need, respecting 
     the values and goals of individuals, their families and other 
     loved ones. It will assist them to live fully in community 
     and will support survivors in their bereavement. Through such 
     care, we believe that God's healing love is revealed.
       The Coalition commends you on your leadership in promoting 
     advance health care planning and we look forward to 
     collaborating with you to facilitate available and accessible 
     high-quality palliative care services across the continuum of 
     care.
           Sincerely,
     James Shaw, MD.,
       Chair, Board of Directors.
     Tina Picchi, MA, BCC,
       Executive Director.
                                  ____

                                             National, Hospice and


                                 Palliative Care Organization,

                                     Alexandria, VA, July 6, 2010.
     Hon. Earl Blumenauer,
     Rayburn House Office Building, Washington, DC.
       Dear Representative Blumenauer: On behalf of the National 
     Hospice and Palliative Care Organization and its more than 
     30,000 provider and individual members, I am writing in 
     support of the Personalize Your Care Act of 2010. While 
     research shows that a large majority of Americans would 
     prefer to die at home, more than seventy-five percent die in 
     hospitals each year. At the same time, additional research 
     shows that when people facing a life-limiting illness have 
     discussions with their physician about end-of-life care 
     preferences, they experience less physical and psychological 
     distress and overall, a better quality of death.
       Your proposed legislation recognizes that with appropriate 
     Medicare and Medicaid coverage for voluntary advance care 
     planning consultations, grants for programs in support of 
     Physician Orders for Life Sustaining Treatment (POLST), 
     advance care planning standards for electronic health records 
     and portability of advanced directives, the American 
     healthcare system can meet the complex needs of our aging 
     population.
       The Personalize Your Care Act would empower patients, 
     decrease the burden on families, and produce end-of-life care 
     outcomes, while increasing care quality and adherence to 
     patient wishes. Enactment of your legislation would mean the 
     realization of many long-time NHPCO goals, especially the 
     provision of coverage for voluntary advance care planning 
     consultation between a patient and their health care 
     practitioner. Discussing advance care planning before a 
     Medicare or Medicaid beneficiary finds him or herself in a 
     medical crisis will help ensure the patient gets the care 
     that he or she wants. One of the most frequent comments from 
     family caregivers that hospice providers hear is ``Why didn't 
     we know about this sooner?'' Coverage for advance care 
     planning consultations would ensure patients and family 
     caregivers knew all of their options earlier.
       NHPCO commends your leadership on the advancement of end-
     of-life care planning. We strongly support passage of this 
     important legislation, and look forward to working with you 
     on this and future legislation that meets the need for all 
     Americans to have access to quality end-of-life care.
           Sincerely,
                                        J. Donald Schumacher, PsyD
     President/CEO.
                                  ____



                                American Hospital Association,

                                    Washington, DC. July 20, 2010.
     Hon. Earl Blumenauer,
     House of Representatives,
     Washington, DC.
       Dear Mr. Blumenauer: On behalf of the American Hospital 
     Association's (AHA) more than 5,000 member hospitals, health 
     systems and other health care organizations, and the 
     physicians and other practitioners that work in hospitals, I 
     commend you for introducing the Personalize Your Care Act of 
     2010.
       Your legislation recognizes that today's fast-paced health 
     care environment often impedes effective communication 
     between patients, families and caregivers--physician visits 
     and hospital stays are shorter, medical care more complex, 
     and more patients want to take an active role in care 
     decisions. Hospitals have been doing ever more to foster 
     clearer, more frequent and more satisfying communication 
     during the hospital experience, and these discussions add 
     quality and value to patient care. Your legislation rightly 
     addresses the need for Medicare and Medicaid to recognize the 
     time and training required of physicians and other 
     practitioners to talk with patients in advance to clearly 
     articulate their wishes for treatment if they suffer a life-
     threatening medical crisis.
       Three years ago, the AHA joined in a campaign designed to 
     encourage patients to articulate their wishes for care--a 
     campaign we called ``Put it in Writing.'' Your bill would 
     ensure that patients could draw on the knowledge and 
     perspective of a trusted clinician as they seek to articulate 
     their desires. We look forward to working with you toward 
     enactment of this important initiative.
           Sincerely,
                                                     Rick Pollack,
     Executive Vice President.

                          ____________________